Siaw-Teng Liaw

• MBBS, PhD, FRACGP, FACHI FAIDH FACMI FIAHSI
• Professor Emeritus at UNSW Sydney

Introduction: Like many countries, Australia’s hospital system is under pressure with pre-school children comprising the largest proportion of all primary care-type emergency department presentations. General practitioners (GPs) must refer patients to specialists and waiting times to see specialists in paediatric hospital clinics are up to 12 month...

Background Encouraging healthy childhood development and aiding the early identification of developmental difficulties are crucial to providing the best possible outcomes. Young children in rural areas are at a higher risk of missing timely developmental screening than their non-rural counterparts. This study examined the feasibility and acceptabil...

Background Tuberculosis (TB) remains a significant health concern, contributing to the highest mortality among infectious diseases worldwide. However, none of the various TB diagnostic tools introduced is deemed sufficient on its own for the diagnostic pathway, so various artificial intelligence (AI)–based methods have been developed to address thi...

Background Healthcare providers are critical to the successful, sustainable and impactful implementation of digital health. Despite the growing interest, Digital Health Innovations (DHIs) are often implemented without sufficient evidence, leading to numerous short-lived projects and a limited understanding of their impact on health systems and outc...

Background In the last three decades, in people with diabetes, while the mortality and morbidity due to cardiovascular disease (CVD) and stroke have declined, the incidence of end-stage renal disease (ESRD) has crept up. The precise cause for this shift is unknown. Intriguingly, during the same period, the incidence of diabetes in younger people ha...

BACKGROUND Tuberculosis (TB) remains a significant health concern, contributing to the highest mortality among infectious diseases worldwide. However, none of the various TB diagnostic tools introduced is deemed sufficient on its own for the diagnostic pathway, so various artificial intelligence (AI)–based methods have been developed to address thi...

UNSTRUCTURED Digital health is having its moment on the diplomatic stage. Recognising the rapidly accelerating digital transformation of healthcare following COVID-19, the ‘G20 Bali Leaders’ Declaration’ called for “continued international dialogue and collaboration on the establishment of trusted global digital health networks, aligning well with...

Background and objectives: Tuberculosis infection (TBI) screening and treatment delivered from primary care could hold the key to achieving tuberculosis (TB) elimination in low TB burden countries. This scoping review was undertaken to understand how elements of the cascade of care for TBI screening and treatment have been implemented in primary c...

Background Children and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in...

Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular disease (CVD) and its mortality, independent of mean blood pressure (BP). However, in real world clinical practice this phenomenon is under-appreciated by clinicians. Serial BPV measured at clinical visits are frequently considered random fluctuations. This scoping re...

Statins are a group of medications that lower lipid and are used for primary and secondary prevention of cardiovascular diseases (CVD). Patients can either be partially (15%) or completely (5%) intolerant to statins. Symptoms of statin intolerance can include muscle aches (myalgia), weakness, cramps, myopathy, diabetes mellitus, and elevated creati...

Visit-to-visit (VVV) blood pressure variability (BPV) is associated with cardiovascular disease. However, in practice, BPV at sequential clinic visits is often regarded as mere random fluctuations and frequently under-appreciated by the clinicians. Therefore, this meta-analysis aims to compare the effect size of VVV BPV on cardiovascular outcome, b...

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Background Children and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in...

Background Encouraging healthy childhood development and aiding the early identification of developmental difficulties are crucial to providing the best possible outcomes. Young children in rural areas are at a higher risk of missing timely developmental screening than their non-rural counterparts. This study examined the feasibility and acceptabil...

Objectives In this overview, we describe theObservational Medical Outcomes Partnership Common Data Model (OMOP-CDM), the established governance processes employed in EMR data repositories, and demonstrate how OMOP transformed data provides a lever for more efficient and secure access to electronic medical record (EMR) data by health service provide...

Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular disease (CVD), independently of mean blood pressure (BP). However, in real world clinical practice, this phenomenon is frequently considered as random fluctuation. This review aimed to investigate the differences among studies investigating visit-to-visit BPV and CVD...

Statin is a group of lipid/cholesterol-lowering medications that is commonly used for primary and secondary prevention of cardiovascular diseases (CVD). In Australia, this is the first line of pharmacological therapy for CVD risk management. High-risk patients who do not adhere to lipid-modifying medicines have an increased risk of CVD mortality, h...

Transfer Learning (TL) is a strategic solution to handle vast data volume requirements in Deep Learning (DL). It transfers knowledge learned from a large base dataset, as a Pre-Trained Model (PTM), to a new domain. In this study, we introduce an ensemble of classifiers trained on features extracted from some intermediate layers of a PTM for Tubercu...

Introduction: Providing affordable, accessible, quality health services is critical to attaining Universal Health Coverage (UHC). Despite this, progress in many Pacific Island countries and territories could be faster. Digital health is an advancement in information communication technology that is anticipated to change health care delivery. Method...

Purpose HealthPathways is an online decision support portal, primarily aimed at General Practitioners (GPs), that provides easy to access and up to date clinical, referral and resource pathways. It is free to access, with the intent of providing the right care, at the right place, at the right time. This case study focuses on the experience and lea...

Background Significant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomi...

Introduction: To achieve Universal Health Coverage and the United Nations' (UN) Sustainable Development Goals (SDGs) agenda for 2030, the World Health Organisation (WHO) recommended the use of social enterprise, digital technology, and citizen engagement in the delivery of Integrated People-Centred Health Services (IPCHS) as part of its strategic...

Digital health is having its moment on the diplomatic stage. Recognising the rapidly accelerating digital transformation of healthcare following COVID-19, the ‘G20 Bali Leaders’ Declaration’ called for “continued international dialogue and collaboration on the establishment of trusted global digital health networks, aligning well with the World Hea...

Objectives: One Health considers human, animal and environment health as a continuum. The COVID-19 pandemic started with the leap of a virus from animals to humans. Integrated management systems (IMS) should provide a coherent management framework, to meet reporting requirements and support care delivery. We report IMS deployment during, and retent...

Background: Tuberculosis (TB) was the leading infectious cause of mortality globally prior to COVID-19 and chest radiography has an important role in the detection, and subsequent diagnosis, of patients with this disease. The conventional experts reading has substantial within- and between-observer variability, indicating poor reliability of human...

This study explored the impacts of COVID-19 on the mental health (MH)-related visits to general practices (GPs) among children and young people (CYP) up to 18 years of age in Australia. This study analysed national-level data captured by the NPS MedicineWise program on monthly CYP MH-related visits per 10,000 visits to GPs from January 2014 to Sept...

Background: Machine learning has been shown to outperform traditional statistical methods for risk prediction model development. We aimed to develop machine learning-based risk prediction models for cardiovascular mortality and hospitalisation for ischemic heart disease (IHD) using self-reported questionnaire data. Methods: The 45 and Up Study w...

Background: Although HIV treatment-as-prevention reduces individual-level HIV transmission, population-level effects are unclear. We aimed to investigate whether treatment-as-prevention could achieve population-level reductions in HIV incidence among gay, bisexual, and other men who have sex with men (GBM) in Australia's most populous states, New...

INTRODUCTION The Journal of the American Medical Informatics Association (JAMIA) focus issue on Global Health Informatics (GHI) examines how health informatics can address global health issues. The selected papers discuss how informatics can improve health outcomes, especially in low- and middle-income countries (LMICs). The articles in this issue...

BACKGROUND The Health eLiteracy for Prevention in General Practice (HeLP-GP) trial is a primary healthcare-based behavior change intervention for weight loss in overweight and obese Australians from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic condit...

Background The Health eLiteracy for Prevention in General Practice trial is a primary health care–based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for ch...

Background:Significant challenges remain in the early identification of child developmental conditions in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. As part of a cluster randomised c...

Objectives To evaluate a multifaceted intervention on diet, physical activity and health literacy of overweight and obese patients attending primary care. Design A pragmatic two-arm cluster randomised controlled trial. Setting Urban general practices in lower socioeconomic areas in Sydney and Adelaide. Participants We aimed to recruit 800 patien...

Objective: A literature review of capability maturity models (MMs) to inform the conceptualization, development, implementation, evaluation, and mainstreaming of MMs in digital health (DH). Methods: Electronic databases were searched using "digital health," "maturity models," and related terms based on the Digital Health Profile and Maturity Ass...

Objectives Implementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents’/caregivers’ experiences and perceptions about a digital developmental surveillance pathway for autism, the autism s...

BACKGROUND Tuberculosis (TB) was the leading infectious cause of mortality globally prior to COVID-19 and chest radiography has an important role in the detection, and subsequent diagnosis, of patients with this disease. The conventional experts reading has substantial within- and between-observer variability, indicating poor reliability of human r...

Introduction Australia’s current healthcare system for children is neither sustainable nor equitable. As children (0–4 years) comprise the largest proportion of all primary care-type emergency department presentations, general practitioners (GPs) report feeling undervalued as an integral member of a child’s care, and lacking in opportunities for su...

Background and Objectives: Statins have been extensively utilised in atherosclerotic cardiovascular disease (ASCVD) prevention and can inhibit inflammation. However, the association between statin therapy, subclinical inflammation and associated health outcomes is poorly understood in the primary care setting. Materials and Methods: Primary care el...

The provision of adequate health services is critical to achieving the Sustainable Development Goals (SDGs), attaining universal health coverage (UHC) and realizing the Pacific’s own “Healthy Islands” vision. Despite this, progress in health service delivery in many Pacific Island countries and territories (PICTs) has been slow. Recent advancements...

Introduction The increasing prevalence of developmental disorders in early childhood poses a significant global health burden. Early detection of developmental problems is vital to ensure timely access to early intervention, and universal developmental surveillance is recommended best practice for identifying issues. Despite this, there is currentl...

In the wake of COVID -19, several nations have sought to implement digital vaccine passports (DVPs) to enable the resumption of international travel. Comprising a minimum dataset for each unique individual, DVPs have the makings of a global electronic health record, broaching key issues involved in building a global digital health ecosystem. Debate...

Background: It is important that research conducted in general practice is ethical and technically robust. Electronic health records (EHRs) have high potential to contribute to research and policy that benefits both individual patients and the broader community. General practitioners are increasingly approached to make EHRs available for research,...

Objective: While the COVID-19 pandemic provided a global stimulus for digital health capacity, its development has often been inequitable, short-term in planning, and lacking in health system coherence. Inclusive digital health and the development of resilient health systems are broad outcomes that require a systematic approach to achieving them. T...

Background and objectives: Watch Me Grow - Electronic (WMG-E) platform is an online resource to enhance the capacity of general practitioners (GPs) to involve parents in developmental surveillance. The aim of this study was to evaluate the acceptability and perceived utility of WMG-E. Method: Semi-structured interviews were conducted with GPs/pa...

Importance: More than 1 billion adults have hypertension globally, of whom 70% cannot achieve their hypertension control goal with monotherapy alone. Data are lacking on clinical use patterns of dual combination therapies prescribed to patients who escalate from monotherapy. Objective: To investigate the most common dual combinations prescribed...

Background We investigated whether we could use influenza data to develop prediction models for COVID-19 to increase the speed at which prediction models can reliably be developed and validated early in a pandemic. We developed COVID-19 Estimated Risk (COVER) scores that quantify a patient’s risk of hospital admission with pneumonia (COVER-H), hosp...

Actualizing the vision of Global Digital Health is a central issue on the Global Health Diplomacy agenda. The COVID-reinforced need for accelerated digital health progress will require political structures and processes to build a foundation for Global Digital Health. Simultaneously, Global Health Diplomacy uses digital technologies in its enactmen...

Background The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an a...

Introduction: Over one billion adults have hypertension globally, of whom 70% cannot achieve hypertension control with monotherapy. Data are lacking on patterns of dual combination therapies prescribed to patients who escalate from monotherapy. Methods: We described dual combination therapy utilization using eleven electronic health record database...

Background Evidence-based medicine (EBM) is a core skillset for enhancing the quality and safety of patients’ care. Online EBM education could improve clinicians’ skills in EBM, particularly when it is conducted during vocational training. There are limited studies on the impact of online EBM training on clinical practice among general practitioner...

Providing appropriate care for people suffering from COVID-19, the disease caused by the pandemic SARS-CoV-2 virus, is a significant global challenge. Many individuals who become infected may have pre-existing conditions that may interact with COVID-19 to increase symptom severity and mortality risk. COVID-19 patient comorbidities are likely to be...

Background: Over one billion adults have hypertension globally, of whom approximately 70% cannot achieve blood pressure control goal with monotherapy alone. Data are lacking on patterns of dual combination therapies prescribed to patients who escalate from monotherapy in routine practice. Methods: Using eleven electronic health record databases tha...

Objective The COVID-19 pandemic and its socio-economic impacts have disrupted our health systems and society. We sought to examine informatics and digital health strategies that supported the primary care response to COVID-19 in Australia. Specifically, the review aims to answer: how Australian primary health care responded and adapted to COVID-19,...

Background In 1995, Pacific Health Ministers articulated their vision of a healthy Pacific as ‘a place where children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; where ecological balance is a source of pride; and where the ocean is protected.’ Central to this vision is the achievement o...

Engaging citizens with digital technology to co-create data, information and knowledge has widely become an important strategy for informing the policy response to COVID-19 and the 'infodemic' of misinformation in cyberspace. This move towards digital citizen participation aligns well with the United Nations' agenda to encourage the use of digital...

Introduction This position statement considers the evolving evidence on the use of coronary artery calcium scoring (CAC) for defining cardiovascular risk in the context of Australian practice and provides advice to health professionals regarding the use of CAC scoring in primary prevention of cardiovascular disease in Australia. Main recommendation...

Background: The early detection of developmental conditions such as autism is vital to ensure children can access appropriate and timely evidence-based supports, services, and interventions. Children who have undetected developmental conditions early in life are more likely to develop later health, developmental, learning, and behavioral issues, wh...

Objective: Internationally, primary care practice had to transform in response to the COVID pandemic. Informatics issues included access, privacy, and security, as well as patient concerns of equity, safety, quality, and trust. This paper describes progress and lessons learned. Methods: IMIA Primary Care Informatics Working Group members from Austr...

Background: SARS-CoV-2 is straining health care systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate patients who require hospitalization from those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospital...

Poster presented at the 2nd Asia Pacific Integrated Care Conference 2019, in Melbourne, Australia.

Introduction: The global commitment to reform primary care systems was reaffirmed in the 2018 Astana Declaration on Primary Health Care. The World Health Organization framework on the Integrated People-Centered Health Services (IPCHS) was designed to implement this agenda, while accelerating progress towards health-focused Sustainable Development...

Objective Toolkits are an important knowledge translation strategy for implementing digital health. We studied how toolkits for the implementation and evaluation of digital health were developed, tested, and reported. Materials and Methods We conducted a systematic review of toolkits that had been used, field tested or evaluated in practice, and p...

Background Evidence-based medicine (EBM) is a core skillset for enhancing the quality and safety of patients’ care. Online EBM education could improve clinicians’ skills in EBM, particularly when it is conducted during vocational training. There are limited studies on the impact of online EBM training on clinical practice among GP registrars (train...

Ambitious World Health Organization targets for disease elimination require monitoring of epidemics using routine health data in settings of decreasing and low incidence. We evaluated two methods commonly applied to routine testing results to estimate incidence rates that assume uniform probability of infection between consecutive negative and posi...

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Objective: Data quality (DQ) must be consistently defined in context. The attributes, metadata, and context of longitudinal real-world data (RWD) have not been formalized for quality improvement across the data production and curation life cycle. We sought to complete a literature review on DQ assessment frameworks, indicators and tools for researc...

Multi-center observational studies require recognition and reconciliation of differences in patient representations arising from underlying populations, disparate coding practices and specifics of data capture. This leads to different granularity or detail of concepts representing the clinical facts. For researchers studying certain populations of...

Introduction Countries need to determine their level of digital health capability maturity to assess and mobilize their knowledge, skills, and resources to systematically develop, implement, evaluate, scale up and maintain large-scale implementations of standards-based interoperable digital health tools. Objective Develop a Digital Health Profile...

Background: Providing appropriate care for people suffering from COVID-19, the disease caused by the pandemic SARS-CoV-2 virus is a significant global challenge. Many individuals who become infected have pre-existing conditions that may interact with COVID-19 to increase symptom severity and mortality risk. COVID-19 patient comorbidities are likely...

Objective This review aimed to examine how mobile health (mHealth) to support integrated people-centred health services has been implemented and evaluated in the World Health Organization (WHO) Western Pacific Region (WPR). Methods Eight scientific databases were searched. Two independent reviewers screened the literature in title and abstract sta...

Background Healthcare organisations are undergoing a major transformational shift in the use of information and digital health technologies. Enterprise architecture (EA) has been incrementally adopted in many healthcare organisations globally to facilitate this change. EA can increase the effectiveness of an organisation’s digital health capabiliti...

South Western Sydney (SWS) is one of the fastest growing regions in the state of New South Wales (Australia). Much of the population live in local government areas (LGAs) with levels of disadvantage higher than the state average, with a predominance of non-communicable and chronic diseases that are typically associated with age-related and behaviou...

Background: SARS-CoV-2 is straining healthcare systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate between patients requiring hospitalization and those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospi...

BACKGROUND SARS-CoV-2 is straining healthcare systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate between patients requiring hospitalization and those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospit...

Background: SARS-CoV-2 is straining healthcare systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate between patients requiring hospitalization and those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hosp...

Objective To develop and externally validate COVID-19 Estimated Risk (COVER) scores that quantify a patient’s risk of hospital admission (COVER-H), requiring intensive services (COVER-I), or fatality (COVER-F) in the 30-days following COVID-19 diagnosis. Methods We analyzed a federated network of electronic medical records and administrative claim...

Objective: To create practical recommendations for the curation of routinely collected health data and artificial intelligence (AI) in primary care with a focus on ensuring their ethical use. Methods: We defined data curation as the process of management of data throughout its lifecycle to ensure it can be used into the future. We used a literature...